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www.mercermarketplace.com/login | 1-855-963-7237
Your Enrollment Checklist
Read this guide for a benefits overview and
helpful tips.
Visit www.mercermarketplace.com/login to
learn more about your personal options.
Use the tools and resources on the website
to help you make your choices.
Select your benefits for 2017. If you do not
enroll, you will have not have benefit
coverage.
Benefits for your life. Your Ohio National Financial Services 2017 Benefits Decision Guide
For financial professional use only
Ohio National Financial Services is pleased to offer a wide selection of benefits for 2017 that
offer you flexibility and choice, an easy online shopping experience and the ability to take
charge of your benefits spending.
Here’s how it works:
Visit www.mercermarketplace.com/login to access Mercer Marketplace 365. The website
features built-in decision support to guide you through the benefits selection process – one
step at a time.
Review the benefits available to you, which are summarized in this guide and on the
website.
Choose the plans that best meet your needs and fit your budget.
Questions?
Mercer Marketplace 365 benefits counselors are ready to help you understand your options
and make the right choices for your needs and budget. Simply call the toll-free number
listed below or visit www.mercermarketplace.com/login and start an online chat for personal
assistance.
1-855-9MERCER (1-855-963-7237)
Monday through Friday, 7 a.m. to 9 p.m. Eastern Time
What happens if I don’t enroll? If you do not enroll, you will default to last year’s enrollment.
Welcome to your 2017 benefits!
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see the Creditable Prescription Drug Coverage and Medicare Notice in the Legal Notices at the back of this booklet for more details.
How to Enroll ................................................................................................................. Page 3
HEALTH BENEFITS
Medical and Prescription Drug Coverage ...................................................................... Page 5
Savings Account ............................................................................................................ Page 8
Dental Insurance ........................................................................................................... Page 10
Vision Insurance ............................................................................................................ Page 11
LIFE
Life Insurance ................................................................................................................ Page 12
MORE BENEFITS
Identity Theft Protection ................................................................................................. Page 13
Pet Insurance ................................................................................................................ Page 13
Auto and Home Insurance ........................................................................................... Page 13
Online Discount Mall ...................................................................................................... Page 13
CONTACT INFORMATION.................................................................................... Page 14
LEGAL NOTICES ..................................................................................................... Page 15
What’s Inside
Visit Mercer Marketplace 365 to enroll in your benefits! www.mercermarketplace.com/login
It’s easy to enroll! The Mercer Marketplace 365 website takes you through your benefits shopping one
decision at a time, providing helpful education and decision support every step of the way. If you don’t have
access to a computer, you can enroll with a benefits counselor by calling 1-855-9MERCER
(1-855-963-7237).
Get started at www.mercermarketplace.com/login.
For your security, your password has been reset. The first time you visit the Mercer Marketplace 365 website to select your options for the 2017 enrollment deadline you will need to reset your password. Please use this format: Your Date of Birth (dd/month/yyyy) i.e. 01Jan2006.
START SHOPPING
Once you’ve logged in, click on the “Get started” button and follow these simple enrollment steps:
1. Profile
• Review your personal information.
• Enter information for any dependents you wish to cover, if needed. This includes dependent Social
Security Numbers and dates of birth.
2. Shop for Benefits
• Answer questions to help identify the best coverage for your needs.
• Compare plan features and costs.
• Use the educational resources to learn more.
• Select the benefits you want to enroll in. Make sure you hit “Save” after each benefit election.
3. Confirm & Finish
• Review the summary of your enrollment selections. You can make changes up until your enrollment
period ends.
• If you’d like, you can print a copy of your Employee Detail Report which summarizes all of your
choices.
How to Enroll
CLICK TO CHAT
If you run into questions while enrolling, a “Chat Now”
button is located in the bottom right corner of each page on
the Mercer Marketplace 365 website. By clicking this, you
will be able to have a secure, live chat with a benefits
counselor during the hours the call center is open. No
phone call required!
CHANGING YOUR BENEFIT SELECTIONS
You can change any of your benefit selections before your enrollment deadlines. Simply return to the Mercer Marketplace 365 website to make changes. After the enrollment deadline, you may be able to make changes to some of your benefits if you have a
change in personal circumstances. For example, if you get married or have a baby, you can add coverage
for your spouse or new child. To change your benefits due to a life event, you must make the change
within 30 days of the event. Visit www.mercermarketplace.com/login or call one of our Mercer
Marketplace 365 benefits counselors at 1-855-9MERCER (1-855-963-7237).
THE MERCER MARKETPLACE 365 WEBSITE: A YEAR-ROUND RESOURCE
After you enroll in your benefits, don’t wait until next year to come back! The website is a great resource
throughout the year for your benefit and coverage information.
Here’s what you’ll find:
Cost of the coverage you are currently enrolled in
Information about your benefits
Detailed plan summaries
Videos and tips to help you get the most out of your coverage
Be sure to add [www.mercermarketplace.com/login] to your online favorites for easy reference all year long!
ACCESS YOUR BENEFITS ANYWHERE
With the Mercer Marketplace 365 “Your Benefits Mobile App”, you’ll have convenient access to your
benefits on the go. Once downloaded, you will log in with the same username and password you use for
the Mercer Marketplace 365 website. You can use the app to access plan information and costs. The
Mobile App is available for download for use on your Apple Device from Apple’s App Store or Google Play
for your Android device.
Take advantage of helpful information and
resources by visiting
www.mercermarketplace.com/login. As
you enroll, you’ll find key information
displayed for each plan, including
coverage details and cost. You’ll also find
a variety of tools, educational videos and
reference documents to help you better
understand your benefit options.
Shopping tip
Medical coverage offers valuable benefits to help you stay
healthy and pay for care if you or your covered family
members become sick or injured.
The medical plans available to you include a range of
coverage levels and costs, giving you the flexibility to select
the plan that is right for you. You’ll find a summary of each of
the plans in this guide. Visit the Mercer Marketplace 365
website at www.mercermarketplace.com/login or call one of
our Mercer Marketplace 365 benefits counselors at
for complete details and 1-855-9MERCER (1-855-963-7237)
plan costs.
Which medical plan is right for you?
When you go online, you can answer a few questions about your medical insurance usage,
payment preference and ability to afford an unexpected medical expense. Then, Mercer
Marketplace 365 will show you one or more plans that may best match your situation. While the
decision is yours, these matches may help you make an appropriate choice.
Before you choose your benefits, think about…
How much health care – and what type of care – did you need this year?
Do you expect your needs to be similar next year? Do you foresee changes?
Do you prefer to pay less from your paycheck and more out of your pocket when you need
care, or more from your paycheck and less out of your pocket when you need care?
Medical and Prescription Drug Coverage
As part of the Affordable Care Act,
most Americans must have medical
insurance or pay a federal tax
penalty. Be sure you’re covered,
either through your employer-
sponsored plan or through another
option available to you, such as your
spouse’s employer benefits or a
government program such as
Medicare or Medicaid.
It’s the law!
Key Words to Know:
Below are general examples of key words to know and are not a guarantee of coverage. Check
your Plan Documents and Benefit Summaries to confirm covered benefits.
Copay: An amount you pay for a covered service each time you use that service. It does not apply
toward the deductible.
Deductible: The amount you pay before the plan begins to pay.
Out-of-Pocket Costs: Expenses you pay yourself, such as deductibles, copays, coinsurance and
non-covered services.
Out-of-Pocket Maximum: The maximum amount you pay for covered services in a year (you may
need to pay additional amounts if coverage is received from an out-of-network provider).
Coinsurance: Percentage of the charge that your plan will pay, typically after you have met the
deductible.
In-Network vs. Out-of-Network
For plans that offer in- and out-of-network benefits, you have the option to see any provider you choose.
However, you’ll save money when receiving care from an in-network provider. To access a list of in-
network providers, click on the carrier’s link from the Mercer Marketplace 365 medical enrollment page.
Prescription Drug Coverage Terms
Do you or a family member take medications? If so, keep in mind that your prescription drug coverage
depends on the medical coverage level you choose.
You’ll see in the medical charts that medications are grouped into three tiers, and the tier that your
medication falls into determines your portion of the drug cost.
TIER YOU PAY WHAT’S COVERED
1 Lowest Cost
Sharing
Most Generic Prescription Drugs
Generic prescription drugs use the same active
ingredients as brand-name prescription drugs
and work the same way. Generic drugs are
equivalent to a brand product in dosage form,
strength, quality, and intended use.
2 Second Lowest
Cost Sharing
Preferred Brand Name Drugs
Drugs sold under a specific trade name that are
favorably priced by the pharmacy plan.
3 Highest Cost
Sharing
Non-Preferred Brand Name Drugs
Drugs sold under a specific trade name that
have a reasonable, more cost-effective
alternative on Tier 1 or Tier 2.
REVIEW YOUR MEDICAL PLAN OPTIONS
Aetna
IN-NETWORK MEDICAL PLAN SUMMARY
$800 DEDUCTIBLE WITH COPAYS
$1,500 DEDUCTIBLE WITH HSA
$2,500 DEDUCTIBLE WITH HSA
HSA Eligible No Yes Yes
In-Network
Preventive Doctor’s Visit Covered at 100% in-network
Individual/Family Deductible
$800/$1,600 $1,500/$3,000 $2,500/$5,000
Individual/Family Out-of-Pocket Max
$2,400/$4,800 $5,200/$6,850 $6,200/$6,850
Plan Coinsurance 80% 80% 70%
Office Visit (Primary Care/Specialist)
$40/$80 copay* 80% after deductible 70% after deductible
Retail Prescriptions
Tier 1 $10 copay* 80% after deductible 70% after deductible
Tier 2 70% (min $25, max $50)* 80% after deductible 70% after deductible
Tier 3 55% (min $40, max $80)* 80% after deductible 70% after deductible
Mail Order Prescriptions
Tier 1 $25 copay* 80% after deductible 70% after deductible
Tier 2 70% (min $62.50, max $125)* 80% after deductible 70% after deductible
Tier 3 55% (min $100, max $200)* 80% after deductible 70% after deductible
* Deductible does not apply.
Helpful information about Deductibles and Out-of-Pocket Maximums
Under the $1,500 Deductible with HSA Plan and $2,500 Deductible with HSA Plan, if you cover any family member(s) in addition to yourself:
The entire Family Deductible must be met before benefits begin to pay out for any family member.
The entire Family Out-of-Pocket Maximum must be met before the plan pays in full for any family member.
For all other plans, if you cover any family member(s) in addition to yourself:
Once one family member meets the Individual Deductible, benefits begin to be paid for that individual.
Once one family member meets the Individual Out-of-Pocket Maximum, the plan pays covered benefits in full for that individual.
You can save money on your health care costs through the use of a tax-
advantaged account that allows you to use before-tax dollars to pay for
eligible expenses. For additional details about the following accounts,
visit www.mercermarketplace.com/login.
Key Words to Know:
Below are general examples of key words to know and are not a
guarantee of coverage. Check your Plan Documents and Benefit
Summaries to confirm covered benefits.
Health Savings Account (HSA): An account funded by you that lets
you set aside a portion of your income, before taxes, to pay for eligible
health care expenses. This type of account is available only to
participants who are enrolled in the $1,500 Deductible Plan with HSA
and $2,500 Deductible Plan with HSA and who are not covered by any
other type of medical plan.
Access your accounts anywhere
The “Your Accounts Mobile App” is available for Health Savings Accounts. Once downloaded, you will log
in to the Mobile App with the spending and savings account username and password you created when
you opened your reimbursement account. These login credentials may differ from your Mercer
Marketplace 365 credentials.
You can use the “Your Accounts Mobile App” to view account balances, upload receipts, review plan
details, see your account activity and contact customer service. Health Savings Account investment details
may also be viewed through this app. The Mobile App is available for download for use on your Apple
Device from Apple’s App Store or Google Play for your Android device.
Savings Accounts
What are eligible health
care expenses?
For a complete list of eligible expenses, visit www.irs.gov and see Publication 502. Some examples include:
Office visits
Prescription drugs
Hospital stays and lab work
Speech/occupation/ physical therapy
Dental and vision care
Reminder
Keep documentation to support your use of the money in these accounts for tax purposes.
HEALTH SAVINGS ACCOUNT (HSA)
With the $1,500 Deductible Plan with HSA and $2,500 Deductible Plan with HSA, you’re eligible to
contribute money to a Health Savings Account (HSA). HSAs are tax-advantaged savings accounts you can
use to help pay for eligible health care expenses as you incur them, or you can build up the money in your
account and use it for future expenses, even during retirement. Your HSA is always yours to keep — if you
leave your employer, your HSA goes with you.
Key features
Works like a bank account. Use account funds to pay for eligible health care expenses by using your
debit card when you receive care, or submit a claim for reimbursement for payments you’ve made (up
to the available balance in your account).
You can save. You decide how much to contribute to your HSA and can change that amount at any
time.
It’s tax-advantaged. You don’t pay taxes on contributions made from your paycheck, and the money
will never be taxed when used for eligible health care expenses.
It’s your money. Unused funds can be carried over each year and invested for the future — you can
earn tax-free interest on your HSA balance. Once your account reaches a certain balance, you will
have other investment choices for the money. You can even take the account with you if you terminate
your contract with Ohio National Financial Services, or save it to use during retirement.
You are not eligible to contribute to an HSA if you:
o Are enrolled in Medicare
o Are covered by any health insurance (including Tricare) other than a qualified high deductible
health plan
o Can be claimed as a dependent on another person’s tax return
o Have access to reimbursement under a Health Care Flexible Spending Account (FSA)
established by another employer for you, your spouse, or other family member
Contributions
For 2017, you can make pre-tax contributions from your paycheck up to:
Individual coverage = $3,400
Family coverage = $6,750
If you’re age 55 or older, you can contribute an additional $1,000 per year.
.]
Delta Dental
Your smile says a lot about your overall health. Healthy teeth and gums are an essential part of your
general health and well-being. In fact, research shows there may be a connection between poor dental
health and serious health conditions. Dental exams can detect some health conditions sooner rather
than later. That’s why it’s important to have regular dental check-ups and maintain good oral hygiene.
Key Words to Know:
Below are general examples of key words to know and are not a guarantee of coverage. Check
your Plan Documents and Benefit Summaries to confirm covered benefits.
Annual Maximum Benefit: The maximum total amount the plan will pay during the plan year.
Deductible: The amount you pay before the plan begins to pay.
Preventive Services: Services designed to prevent or diagnose dental conditions including oral
evaluations, routine cleanings, X-rays, fluoride treatments and sealants.
Basic Services: Services such as basic restorations, some oral surgery, endodontics and periodontics.
Major Services: Services such as crowns, dentures, implants and some oral surgery.
Orthodontia: Services such as straightening or moving misaligned teeth and/or jaws with braces and/or
surgery.
IN-NETWORK DENTAL PLAN SUMMARY
ENHANCED WITH ORTHODONTIA BASIC PLUS
Annual Maximum Benefit $2,000 $1,000
IN-NETWORK
Individual/Family Deductible
(waived for preventive services) $50/$150 $50/$150
Preventive Services Plan pays 100%* Plan pays 100%*
Basic Services Plan pays 80% Plan pays 70%
Major Services Plan pays 50% Plan pays 50%
Orthodontia Services Plan pays 50% Not covered
Orthodontia Maximum Lifetime
(in-network and out-of-network)
$1,500**
Not covered
* Deductible does not apply.
** Orthodontia coverage available for eligible children up to age 19.
Dental Insurance
EyeMed
Having an annual eye exam is one of the best ways to make sure you’re keeping your eyes healthy. Eye
exams can help prevent and treat easily correctable vision problems which can cause permanent vision
impairment. You can enroll in vision coverage to save money on eligible vision care expenses, such as
eye exam, glasses and contact lenses.
Key Words to Know:
Below are general examples of key words to know and are not a guarantee of coverage. Check
your Plan Documents and Benefit Summaries to confirm covered benefits.
Copay: An amount you pay for a covered service each time you use that service.
Retail Allowance: Maximum allowance paid toward the cost of vision materials. You are required to pay
any amounts in excess of the retail allowance.
IN-NETWORK VISION PLAN SUMMARY
STANDARD
IN-NETWORK COPAY
Exam $10 (1 per 12 months)
Lenses $25 (1 per 12 months)
Contact Lens Fitting Not to exceed $60 (1 per 12 months)
RETAIL ALLOWANCE
Frames Up to $130; 20% off any amount over allowance (1 per 24 months)
Contact Lenses (in lieu of Frames & Lenses)
Up to $130 (1 per 12 months)
Vision Insurance
MetLife – TERM LIFE, ACCIDENTAL DEATH & DISMEMBERMENT
Life insurance provides important financial protection for you and your family. You can choose from different levels of life insurance coverage to meet your needs.
Employer-Paid Life and Accidental Death and
Dismemberment (AD&D) – Your employer provides you with
a base level of employee term life and accidental death and
dismemberment (AD&D) insurance at no cost to you. This
coverage provides a benefit of $50,000.
Employee-Paid Term Life – To supplement the coverage
provided by your employer, you can purchase additional term
life insurance for yourself. This coverage is tied to your
employment and typically ends if you leave your employer.
However, you may be able to retain this coverage on your
own with the same insurance carrier if you leave your
employer. You must purchase this coverage if you wish to
purchase spouse, and/or child term life.
Spouse Term Life – You can purchase term life insurance for
your spouse. This coverage is tied to your employment, and
typically ends if you leave your employer. However, you may
be able to retain this coverage for your spouse on your own with the same insurance carrier if you leave
your employer.
Child Term Life – You can purchase term life insurance for your dependent children. This coverage is tied
to your employment, and typically ends if you leave your employer. However, you may be able to retain
this coverage for your children on your own with the same insurance carrier if you leave your employer.
Employee-Paid Accidental Death and Dismemberment (AD&D) – You can purchase additional
accidental death and dismemberment (AD&D) insurance for yourself or for yourself and dependents.
Life Insurance
Select a beneficiary It’s important to choose a beneficiary or beneficiaries to receive the policy’s benefit payment in the event of the insured person’s death. You should designate your beneficiary/beneficiaries on www.mercermarketplace.com/login. For Spouse and Child Term Life policies, you (the employee) are automatically listed as the beneficiary.
Statement of Health Any increase or late enrollment in the Employee or Spouse Term Life may require an approval from the insurance company. After electing coverage, you will receive more information.
Important Information
InfoArmor
Get peace of mind by protecting yourself against the damage of identity theft. Identity theft protection
services from InfoArmor® monitor your identity, detect fraud and restore your identity in the event of theft.
Certified privacy advocates are also available to act as dedicated case managers on your behalf to resolve
any identity theft issues.
Nationwide For pet owners, the cost of providing unexpected veterinary care if medical issues arise could add up to
hundreds or even thousands of dollars. Pet insurance through Nationwide gives you peace of mind, and
is a cost-effective way to protect you from the risk of these expenses and provide medical care for your
pet. Mercer Marketplace 365 participants are eligible to receive at least a 5% discount on premiums.
Nationwide offers several policy options to meet a variety of needs and budgets. With this coverage,
you are free to use any veterinarian worldwide.
MetLife
Purchasing auto and home insurance through Mercer Marketplace 365 could provide you with savings
of up to 15%. MetLife gives you access to a variety of personal insurance policies, including
automobile, home*, landlord’s rental dwelling, condo, mobile home, renters, recreational vehicle, boat
and personal excess liability. The premium for this benefit is billed directly to you by MetLife. *Home insurance is not part of MetLife Auto & Home’s benefit offering in Massachusetts and Florida.
PerkSpot
PerkSpot Online Discount Mall offers you 24/7 access to exclusive prices, discounts and offers from
hundreds of local and national merchants. Choose from health clubs, movie theaters, restaurants,
retailers and all major cell phone providers. Offers are updated frequently.
As a Mercer Marketplace 365 participant, you pay nothing for this service. Once you register with an
email address, you can sign up to receive email alerts for discounts you may be interested in. You will
be connected to exclusive discounts and savings of up to 40%.
Identity Theft Protection
Pet Insurance
Auto and Home Insurance
Online Discount Mall
You’ll find many details about the Ohio National Financial Services benefit plans on the Mercer Marketplace
365 website. However, you can use this table if you need to contact a benefit provider directly.
BENEFIT ADMINISTRATOR PHONE NUMBER WEBSITE
Medical and Prescription Aetna 1-888-982-3862 www.aetna.com
Savings Account Mercer Marketplace 365
1-855-963-7237 www.mercermarketplace.com/login
Dental Delta Dental 1-800-524-0149 www.deltadentaloh.com
Vision EyeMed 1-866-939-3633 www.eyemedvision.com
Identity Theft InfoArmor www.infoarmor.com/ONFS
Pet Insurance Nationwide www.petinsurance.com
Auto and Home MetLife www.metlife.com/group-auto/mmx
Online Discount Mall PerkSpot www.mercer.perkspot.com
Contact Information
Legal Notices Ohio National Financial Services reserves the right to change, amend or terminate any benefits plan at any time for any reason. Participation in a benefit plan is not a promise or guarantee of future employment. Receipt of benefits documents does not constitute eligibility.
The Benefits Decision Guide, combined with these legal notices, provides an overview of the benefits available to you and your family. In the event of a discrepancy between the information presented in the Benefits Decision Guide and official plan documents, the official plan documents will govern.
STATEMENT OF MATERIAL MODIFICATIONS
This enrollment guide constitutes a Summary of Material Modifications (SMM) or Summary of Material Reductions (SMR), as applicable, to The Ohio National Life Insurance Company Agents Welfare Benefits Plan summary plan description (SPD). It is meant to supplement and/or replace certain information in the SPD, so retain it for future reference along with your SPD. Please share these materials with your covered family members.
SUMMARY OF BENEFITS COVERAGE
A Summary of Benefits Coverage (SBC) for each of the employer-sponsored medical plans is available at www.mercermarketplace.com/login. You may also request a paper copy by calling Mercer Marketplace 365.
IMPORTANT NOTICE FROM OHIO NATIONAL FINANCIAL SERVICES ABOUT CREDITABLE PRESCRIPTION DRUG COVERAGE AND MEDICARE
The purpose of this notice is to advise you that the prescription drug coverage listed below under the Ohio National Financial Services medical plan is expected to pay out, on average, at least as much as the standard Medicare prescription drug coverage will pay in 2017. This is known as “creditable coverage.”
Why this is important: if you or your covered dependent(s) are enrolled in any prescription drug coverage during 2017 listed in this notice and are or become covered by Medicare, you may decide to enroll in a Medicare prescription drug plan later and not be subject to a late enrollment penalty — as long as you had creditable coverage within 63 days of your Medicare prescription drug plan enrollment. You should keep this notice with your important records.
If you or your family members aren’t currently covered by Medicare and won’t become covered by Medicare in the next 12 months, this notice doesn’t apply to you.
Please read the notice below carefully. It has information about prescription drug coverage with Ohio National Financial Services and prescription drug coverage available for people with Medicare. It also tells you where to find more information to help you make decisions about your prescription drug coverage.
Notice of creditable coverage
You may have heard about Medicare’s prescription drug coverage (called Part D), and wondered how it would affect you. Prescription drug coverage is available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans also offer more coverage for a higher monthly premium.
Individuals can enroll in a Medicare prescription drug plan when they first become eligible, and each year from October 15 through December 7. Individuals leaving employer/union coverage may be eligible for a Medicare Special Enrollment Period.
If you are covered by one of the Ohio National Financial Services prescription drug plans listed below, you’ll be interested to know that coverage is, on average, at least as good as standard Medicare prescription drug coverage for 2017. This is called creditable coverage. Coverage under one of these plans will help you avoid a late Part D enrollment penalty if you are or become eligible for Medicare and later decide to enroll in a Medicare prescription drug plan.
Aetna $800 Deductible Plan
Aetna $1,500 Deductible Plan
Aetna $2,500 Deductible Plan
If you decide to enroll in a Medicare prescription drug plan and you are an active employee or family member of an active employee, you may also continue your employer coverage. In this case, the employer plan will continue to pay primary or secondary, as it had before you enrolled in a Medicare prescription drug plan. If you waive or drop Ohio National Financial Services coverage, Medicare will be your only payer. You can re-enroll in the employer plan at annual enrollment or if you have a special enrollment event for the Ohio National Financial Services plan.
You should know that if you waive or leave coverage with Ohio National Financial Services and you go 63 days or longer without creditable prescription drug coverage (once your applicable Medicare enrollment period ends), your monthly Part D premium will go up at least 1% per month for every month that you did not have creditable coverage. For example, if you go 19 months without coverage, your Medicare prescription drug plan premium will always be at least 19% higher than what most other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to enroll in Part D.
You may receive this notice at other times in the future — such as before the next period you can enroll in Medicare prescription drug coverage, if this Ohio National Financial Services coverage changes, or upon your request.
For more information about your options under Medicare prescription drug coverage
More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. Medicare participants will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. Here’s how to get more information about Medicare prescription drug plans:
Visit www.medicare.gov for personalized help.
Call your state Health Insurance Assistance Program (see a copy of the Medicare & You handbook for the telephone number).
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov or call 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in a Medicare prescription drug plan after your applicable Medicare enrollment period ends, you may need to provide a copy of this notice when you join a Part D plan to show that you are not required to pay a higher Part D premium amount.
For more information about this notice or your prescription drug coverage, contact:
Alexis Kennedy – Agents Benefits Administrator
1 Financial Way, Cincinnati, OH 45242
1-513-794-5987
HIPAA SPECIAL ENROLLMENT NOTICE Notice of special enrollment rights for health plan coverage If you decline enrollment in an Ohio National Financial Services health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in an Ohio National Financial Services health plan without waiting for the next
enrollment deadline period if you: • Lose other health insurance or group health plan coverage. You must request enrollment within 30 days
after the loss of other coverage. • Gain a new dependent as a result of marriage, birth, adoption or placement for adoption. You must request
health plan enrollment within 30 days after the marriage, birth, adoption or placement for adoption. • Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer
eligible. You must request medical plan enrollment within 60 days after the loss of such coverage.
If you request a change due to a special enrollment event within the 30-day timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. In addition, you may enroll in an Ohio National Financial Services medical plan if you become eligible for a state premium assistance program under Medicaid or CHIP. You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law.
Note: If your dependent becomes eligible for special enrollment rights, you may add the dependent to your current coverage or change to another health plan. Any other currently covered dependents may also switch to the new plan in which you enroll.
WOMEN’S HEALTH AND CANCER RIGHTS ACT (WHCRA) NOTICE
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was performed. • Surgery and reconstruction of the other breast to produce a symmetrical appearance. • Prostheses. • Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your medical carrier at the phone number listed on the back of your ID card.
NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT (NMHPA OR “NEWBORNS’ ACT”) NOTICE
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information on maternity benefits, call your medical carrier at the phone number listed on the back of your ID card.
MICHELLE’S LAW NOTICE Extended dependent medical coverage during student medical leaves The Ohio National Financial Services plan may extend medical coverage for dependent children if they lose eligibility for coverage because of a medically necessary leave of absence from school. Coverage may continue for up to a year, unless your child’s eligibility would end earlier for another reason.
Extended coverage is available if a child’s leave of absence from school — or change in school enrollment status (for example, switching from full-time to part-time status) — starts while the child has a serious illness or injury, is medically necessary, and otherwise causes eligibility for student coverage under the plan to end. Written certification from the child’s physician stating that the child suffers from a serious illness or injury and the leave of absence is medically necessary may be required.
If your child will lose eligibility for coverage because of a medically necessary leave of absence from school and you want his or her coverage to be extended, call Mercer Marketplace 365 at 1-855-963-7237 as soon as the need for the leave is recognized by Ohio National Financial Services. In addition, contact your child’s health plan to see if any state laws requiring extended coverage may apply to his or her benefits.
CHIP/MEDICAID NOTICE Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2016. Contact your State for more information on eligibility.
ALABAMA – Medicaid GEORGIA – Medicaid
Website: http://myalhipp.com/
Phone: 1-855-692-5447
Website: http://dch.georgia.gov/medicaid
- Click on Health Insurance Premium Payment
(HIPP) Phone: 404-656-4507
ALASKA – Medicaid INDIANA – Medicaid
Website:http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Phone (Outside of Anchorage): 1-800-780-9972
Phone (Anchorage): 907-465-2680
Healthy Indiana Plan for low-income adults 19-64
Website: http://www.hip.in.gov
Phone: 1-877-438-4479
All other Medicaid
Website: http://www.indianamedicaid.com
Phone 1-800-403-0864
COLORADO – Medicaid IOWA – Medicaid
Medicaid Website: http://www.colorado.gov/hcpf
Medicaid Customer Contact Center: 1-800-221-3943
Website: http://www.dhs.state.ia.us/hipp/
Phone: 1-888-346-9562
FLORIDA – Medicaid KANSAS – Medicaid
Website: http://flmedicaidtplrecovery.com/hipp/
Phone: 1-877-357-3268
Website: http://www.kdheks.gov/hcf/
Phone: 1-785-296-3512
KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP
Website: http://chfs.ky.gov/dms/default.htm
Phone: 1-800-635-2570
Medicaid Website: http://www.state.nj.us/ humanservices/dmahs/clients/medicaid/
Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/ index.html
CHIP Phone: 1-800-701-0710
LOUISIANA – Medicaid NEW YORK – Medicaid
Website: http://dhh.louisiana.gov/index.cfm/ subhome/1/n/331
Phone: 1-888-342-6207
Website:http://www.nyhealth.gov/health_care/ medicaid/
Phone: 1-800-541-2831
MAINE – Medicaid NORTH CAROLINA – Medicaid
Website: http://www.maine.gov/dhhs/ofi/ publicassistance/index.html
Phone: 1-800-442-6003
TTY: Maine relay 711
Website: http://www.ncdhhs.gov/dma
Phone: 919-855-4100
MASSACHUSETTS – Medicaid and CHIP NORTH DAKOTA – Medicaid
Website: http://www.mass.gov/MassHealth
Phone: 1-800-462-1120
Website:http://www.nd.gov/dhs/services/ medicalserv/medicaid/
Phone: 1-844-854-4825
MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP
Website: http://mn.gov/dhs/ma/
Phone: 1-800-657-3739
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
MISSOURI – Medicaid OREGON – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/ pages/hipp.htm
Phone: 573-751-2005
Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov
Phone: 1-800-699-9075
MONTANA – Medicaid PENNSYLVANIA – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcare Programs/HIPP
Phone: 1-800-694-3084
Website: http://www.dhs.pa.gov/hipp
Phone: 1-800-692-7462
NEBRASKA – Medicaid RHODE ISLAND – Medicaid
Website: http://dhhs.ne.gov/Children_Family_ Services/AccessNebraska/Pages/accessnebraska_index.aspx
Phone: 1-855-632-7633
Website: http://www.eohhs.ri.gov/
Phone: 401-462-5300
NEVADA – Medicaid SOUTH CAROLINA – Medicaid
Medicaid Website: http://dwss.nv.gov/
Medicaid Phone: 1-800-992-0900
Website: http://www.scdhhs.gov
Phone: 1-888-549-0820
NEW HAMPSHIRE – Medicaid SOUTH DAKOTA - Medicaid
Website:http://www.dhhs.nh.gov/oii/documents/ hippapp.pdf
Phone: 603-271-5218
Website: http://dss.sd.gov
Phone: 1-888-828-0059
TEXAS – Medicaid
Website: http://gethipptexas.com/
Phone: 1-800-440-0493
UTAH – Medicaid and CHIP WASHINGTON – Medicaid
Website: Medicaid: http://health.utah.gov/medicaid
CHIP: http://health.utah.gov/chip
Phone: 1-877-543-7669
Website: http://www.hca.wa.gov/medicaid/ premiumpymt/pages/index.aspx
Phone: 1-800-562-3022 ext. 15473
VERMONT– Medicaid WEST VIRGINIA – Medicaid
Website: http://www.greenmountaincare.org/
Phone: 1-800-250-8427
Website:http://www.dhhr.wv.gov/bms/ Medicaid%20Expansion/Pages/default.aspx
Phone: 1-877-598-5820, HMS Third Party Liability
VIRGINIA – Medicaid and CHIP WISCONSIN – Medicaid and CHIP
Medicaid Website: http://www.coverva.org/ programs_premium_assistance.cfm
Medicaid Phone: 1-855-242-8282
CHIP Website: http://www.coverva.org/programs _premium_assistance.cfm
CHIP Phone: 1-855-242-8282
Website: https://www.dhs.wisconsin.gov/ publications/p1/p10095.pdf
Phone: 1-800-362-3002
WYOMING – Medicaid
Website: https://wyequalitycare.acs-inc.com/
Phone: 1-855-294-2127
To see if any other states have added a premium assistance program since January 31, 2016, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565
OHIO NATIONAL FINANCIAL SERVICES HIPAA PRIVACY NOTICE
Please carefully review this notice. It describes how medical information about you may be used and disclosed and how you can get access to this information.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on the use and disclosure of individual health information by Ohio National Financial Services health plans. This information, known as protected health information (PHI), includes almost all individually identifiable health information held by a plan — whether received in writing, in an electronic medium or as an oral communication. This notice describes the privacy practices of the Ohio National Financial Services’s self-insured health plans. The plans covered by this notice may share health information with each other to carry out treatment, payment or health care operations. These plans are collectively referred to as the Plan in this notice, unless specified otherwise.
The Plan’s duties with respect to health information about you
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. If you participate in an insured plan option, you will receive a notice directly from the Insurer. It’s important to note that these rules apply to the Plan, not Ohio National Financial Services as an employer — that’s the way the HIPAA rules work. Different policies may apply to other Ohio National Financial Services programs or to data unrelated to the Plan.
How the Plan may use or disclose your health information
The privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of health care treatment, payment activities and health care operations. Here are some examples of what that might entail:
• Treatment includes providing, coordinating, or managing health care by one or more health care providers or doctors. Treatment can also include coordination or management of care between a provider and a third party, and consultation and referrals between providers. For example, the Plan may share your health information with physicians who are treating you.
• Payment includes activities by this Plan, other plans, or providers to obtain premiums, make coverage determinations, and provide reimbursement for health care. This can include determining eligibility, reviewing services for medical necessity or appropriateness, engaging in utilization management activities, claims management, and billing; as well as performing “behind the scenes” plan functions, such as risk adjustment, collection or reinsurance. For example, the Plan may share information about your coverage or the expenses you have incurred with another health plan to coordinate payment of benefits.
• Health care operations include activities by this Plan (and, in limited circumstances, by other plans or providers), such as wellness and risk assessment programs, quality assessment and improvement activities, customer service and internal grievance resolution. Health care operations also include evaluating vendors; engaging in credentialing, training and accreditation activities; performing underwriting or premium rating; arranging for medical review and audit activities; and conducting business planning and development. For example, the Plan may use information about your claims to audit the third parties that approve payment for Plan benefits.
The amount of health information used, disclosed or requested will be limited and, when needed, restricted to the minimum necessary to accomplish the intended purposes, as defined under the HIPAA rules. If the Plan uses or discloses PHI for underwriting purposes, the Plan will not use or disclose PHI that is your genetic information for such purposes.
How the Plan may share your health information with Ohio National Financial Services
The Plan, or its health insurer or HMO, may disclose your health information without your written authorization to Ohio National Financial Services for plan administration purposes. Ohio National Financial Services may need your health information to administer benefits under the Plan. Ohio National Financial Services agrees not to use or disclose your health information other than as permitted or required by the Plan documents and by law. Human Resources Benefits Team Members are the only Ohio National Financial Services employees who will have access to your health information for plan administration functions.
Here’s how additional information may be shared between the Plan and Ohio National Financial Services, as allowed under the HIPAA rules:
• The Plan, or its insurer or HMO, may disclose “summary health information” to Ohio National Financial Services, if requested, for purposes of obtaining premium bids to provide coverage under the Plan or for modifying, amending, or terminating the Plan. Summary health information is information that summarizes participants’ claims information, from which names and other identifying information have been removed.
• The Plan, or its insurer or HMO, may disclose to Ohio National Financial Services information on whether an individual is participating in the Plan or has enrolled or disenrolled in an insurance option or HMO offered by the Plan.
In addition, you should know that Ohio National Financial Services cannot and will not use health information obtained from the Plan for any employment-related actions. However, health information collected by Ohio National Financial Services from other sources — for example, under the Family and Medical Leave Act, Americans with Disabilities Act, or workers’ compensation programs — is not protected under HIPAA (although this type of information may be protected under other federal or state laws).
Other allowable uses or disclosures of your health information
In certain cases, your health information can be disclosed without authorization to a family member, close friend, or other person you identify who is involved in your care or payment for your care. Information about your location, general condition, or death may be provided to a similar person (or to a public or private entity authorized to assist in disaster relief efforts). You’ll generally be given the chance to agree or object to these disclosures (although exceptions may be made — for example, if you’re not present or if you’re incapacitated). In addition, your health information may be disclosed without authorization to your legal representative. The Plan also is allowed to use or disclose your health information without your written authorization for the following activities:
Workers’ compensation Disclosures to workers’ compensation or similar legal programs that provide benefits for work-related injuries
or illness without regard to fault, as authorized by and necessary to comply with the laws
Necessary to prevent serious
threat to health
or safety
Disclosures made in the good-faith belief that releasing your health information is necessary to prevent or
lessen a serious and imminent threat to public or personal health or safety, if made to someone reasonably
able to prevent or lessen the threat (or to the target of the threat); includes disclosures to help law
enforcement officials identify or apprehend an individual who has admitted participation in a violent crime
that the Plan reasonably believes may have caused serious physical harm to a victim, or where it appears
the individual has escaped from prison or from lawful custody
Public health activities
Disclosures authorized by law to persons who may be at risk of contracting or spreading a disease or
condition; disclosures to public health authorities to prevent or control disease or report child abuse or
neglect; and disclosures to the Food and Drug Administration to collect or report adverse events or product
defects
Victims of abuse, neglect, or
domestic violence
Disclosures to government authorities, including social services or protected services agencies authorized by
law to receive reports of abuse, neglect or domestic violence, as required by law or if you agree or the Plan
believes that disclosure is necessary to prevent serious harm to you or potential victims (you’ll be notified of
the Plan’s disclosure if informing you won’t put you at further risk)
Judicial and administrative
proceedings
Disclosures in response to a court or administrative order, subpoena, discovery request or other lawful
process (the plan may be required to notify you of the request or receive satisfactory assurance from the
party seeking your health information that efforts were made to notify you or to obtain a qualified protective
order concerning the information)
Law enforcement purposes
Disclosures to law enforcement officials required by law or legal process, or to identify a suspect, fugitive,
witness or missing person; disclosures about a crime victim if you agree or if disclosure is necessary for
immediate law enforcement activity; disclosures about a death that may have resulted from criminal conduct;
and disclosures to provide evidence of criminal conduct on the plan’s premises
Decedents Disclosures to a coroner or medical examiner to identify the deceased or determine cause of death; and to
funeral directors to carry out their duties
Organ, eye, or tissue donation Disclosures to organ procurement organizations or other entities to facilitate organ, eye, or tissue donation
and transplantation after death
Research purposes
Disclosures subject to approval by institutional or private privacy review boards, subject to certain
assurances and representations by researchers about the necessity of using your health information and the
treatment of the information during a research project
Health oversight activities
Disclosures to health agencies for activities authorized by law (audits, inspections, investigations or licensing
actions) for oversight of the health care system, government benefits programs for which health information
is relevant to beneficiary eligibility, and compliance with regulatory programs or civil rights laws
Specialized government functions
Disclosures about individuals who are armed forces personnel or foreign military personnel under
appropriate military command; disclosures to authorized federal officials for national security or intelligence
activities; and disclosures to correctional facilities or custodial law enforcement officials about inmates
HHS investigations Disclosures of your health information to the Department of Health and Human Services to investigate or
determine the Plan’s compliance with the HIPAA privacy rule
Except as described in this notice, other uses and disclosures will be made only with your written authorization. For example, in most cases, the Plan will obtain your authorization before it communicates with you about products or programs if the Plan is being paid to make those communications. If we keep psychotherapy notes in our records, we will obtain your authorization in some cases before we release those records. The Plan will never sell your health information unless you have authorized us to do so. You may revoke your authorization as allowed under the HIPAA rules. However, you can’t revoke your authorization with respect to disclosures the Plan has already made. You will be notified of any unauthorized access, use, or disclosure of your unsecured health information as required by law.
The Plan will notify you if it becomes aware that there has been a loss of your health information in a manner that could compromise the privacy of your health information.
Your individual rights
You have the following rights with respect to your health information the Plan maintains. These rights are subject to certain limitations, as discussed below. This section of the notice describes how you may exercise each individual right.
Right to request restrictions on certain uses and disclosures of your health information and the Plan’s right to refuse
You have the right to ask the Plan to restrict the use and disclosure of your health information for treatment, payment, or health care operations, except for uses or disclosures required by law. You have the right to ask the Plan to restrict the use and disclosure of your health information to family members, close friends, or other persons you identify as being involved in your care or payment for your care. You also have the right to ask the Plan to restrict use and disclosure of health information to notify those persons of your location, general condition, or death — or to coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise this right, your request to the Plan must be in writing.
The Plan is not required to agree to a requested restriction. If the Plan does agree, a restriction may later be terminated by your written request, by agreement between you and the Plan (including an oral agreement), or unilaterally by the Plan for health information created or received after you’re notified that the Plan has removed the restrictions. The Plan may also disclose health information about you if you need emergency treatment, even if the Plan has agreed to a restriction.
An entity covered by these HIPAA rules (such as your health care provider) or its business associate must comply with your request that health information regarding a specific health care item or service not be disclosed to the Plan for purposes of payment or health care operations if you have paid out of pocket and in full for the item or service.
Right to receive confidential communications of your health information
If you think that disclosure of your health information by the usual means could endanger you in some way, the Plan will accommodate reasonable requests to receive communications of health information from the Plan by alternative means or at alternative locations.
If you want to exercise this right, your request to the Plan must be in writing and you must include a statement that disclosure of all or part of the information could endanger you.
Right to inspect and copy your health information
With certain exceptions, you have the right to inspect or obtain a copy of your health information in a “designated record set.” This may include medical and billing records maintained for a health care provider; enrollment, payment, claims adjudication and case or medical management record systems maintained by a plan; or a group of records the Plan uses to make decisions about individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings. The Plan may deny your right to access, although in certain circumstances, you may request a review of the denial.
If you want to exercise this right, your request to the Plan must be in writing. Within 30 days of receipt of your request (60 days if the health information is not accessible on site), the Plan will provide you with one of these responses:
• The access or copies you requested. • A written denial that explains why your request was denied and any rights you may have to have the denial
reviewed or file a complaint. • A written statement that the time period for reviewing your request will be extended for no more than 30
more days, along with the reasons for the delay and the date by which the Plan expects to address your request.
You may also request your health information be sent to another entity or person, so long as that request is clear, conspicuous and specific. The Plan may provide you with a summary or explanation of the information instead of access to or copies of your health information, if you agree in advance and pay any applicable fees. The Plan also may charge reasonable fees for copies or postage. If the Plan doesn’t maintain the health information but knows where it is maintained, you will be informed where to direct your request.
If the Plan keeps your records in an electronic format, you may request an electronic copy of your health information in a form and format readily producible by the Plan. You may also request that such electronic health information be sent to another entity or person, so long as that request is clear, conspicuous and specific. Any charge that is assessed to you for these copies must be reasonable and based on the Plan’s cost.
Right to amend your health information that is inaccurate or incomplete
With certain exceptions, you have a right to request that the Plan amend your health information in a designated record set. The Plan may deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by the Plan (unless the person or entity that created the information is no longer available), is not part of the designated record set, or is not available for inspection (e.g., psychotherapy notes or information compiled for civil, criminal or administrative proceedings).
If you want to exercise this right, your request to the Plan must be in writing, and you must include a statement to support the requested amendment. Within 60 days of receipt of your request, the Plan will take one of these actions:
• Make the amendment as requested. • Provide a written denial that explains why your request was denied and any rights you may have to
disagree or file a complaint. • Provide a written statement that the time period for reviewing your request will be extended for no more
than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.
Right to receive an accounting of disclosures of your health information
You have the right to a list of certain disclosures of your health information the Plan has made. This is often referred to as an “accounting of disclosures.” You generally may receive this accounting if the disclosure is required by law, in connection with public health activities, or in similar situations listed in the table earlier in this notice, unless otherwise indicated below.
You may receive information on disclosures of your health information for up to six years before the date of your request. You do not have a right to receive an accounting of any disclosures made in any of these circumstances:
• For treatment, payment or health care operations. • To you about your own health information. • Incidental to other permitted or required disclosures. • Where authorization was provided. • To family members or friends involved in your care (where disclosure is permitted without authorization). • For national security or intelligence purposes or to correctional institutions or law enforcement officials in
certain circumstances. • As part of a “limited data set” (health information that excludes certain identifying information).
In addition, your right to an accounting of disclosures to a health oversight agency or law enforcement official may be suspended at the request of the agency or official.
If you want to exercise this right, your request to the Plan must be in writing. Within 60 days of the request, the Plan will provide you with the list of disclosures or a written statement that the time period for providing this list will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request. You may make one request in any 12-month period at no cost to you, but the Plan may charge a fee for subsequent requests. You’ll be notified of the fee in advance and have the opportunity to change or revoke your request.
Right to obtain a paper copy of this notice from the Plan upon request
You have the right to obtain a paper copy of this privacy notice upon request. Even individuals who agreed to receive this notice electronically may request a paper copy at any time.
Changes to the information in this notice
The Plan must abide by the terms of the privacy notice currently in effect. This notice takes effect on January 1, 2017. However, the Plan reserves the right to change the terms of its privacy policies, as described in this notice, at any time and to make new provisions effective for all health information that the Plan maintains. This includes health information that was previously created or received, not just health information created or received after the policy is changed. If changes are made to the Plan’s privacy policies described in this notice, you will be provided with a revised privacy notice.
Complaints
If you believe your privacy rights have been violated or your Plan has not followed its legal obligations under HIPAA, you may complain to the Plan and to the Secretary of Health and Human Services. You won’t be retaliated against for filing a complaint. To file a complaint, contact Michelle Wilson at 513-794-6547.
Contact
For more information on the Plan’s privacy policies or your rights under HIPAA, contact Emily Bae at 513-794-6779.
New Health Insurance Marketplace Coverage Options and Your Health Coverage
PART A: GENERAL INFORMATION
When key parts of the health care law took effect in 2014, there became a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in November of every year for coverage starting as early as the following January.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.
1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution – as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan description or contact Alexis Kennedy – Agents Benefits Administrator at 1-513-794-5987. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and
contact information for a Health Insurance Marketplace in your area. 1 An employer-sponsored health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs
covered by the plan is no less than 60 percent of such costs.
PART B: INFORMATION ABOUT HEALTH COVERAGE OFFERED BY YOUR EMPLOYER
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer name: Ohio National Financial Services 4. Employer Identification Number (EIN): 31-0397080
5. Employer address: 1 Financial Way 6. Employer phone number: 1-513-794-5987
7. City: Cincinnati 8. State: Ohio 9. ZIP code: 45242
10. Who can we contact about employee health coverage at this job? Alexis Kennedy – Benefits and Compensation Admin
11. Phone number (if different from above) 12. Email address: [email protected]
Here is some basic information about health coverage offered by this employer:
• As your employer, we offer a health plan to:
☒ All employees. Eligible employees are:
☐ Some employees. Eligible employees are:
• With respect to dependents:
☒ We do offer coverage. Eligible dependents are: Spouse (Opposite sex, same sex), Child(ren), Step
child(ren)
☐ We do not offer coverage.
☒ If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is
intended to be affordable, based on employee wages.
Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount. If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here’s the employer information you’ll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.